WO2018013329A1 - Cryoablation épicardique - Google Patents

Cryoablation épicardique Download PDF

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Publication number
WO2018013329A1
WO2018013329A1 PCT/US2017/039362 US2017039362W WO2018013329A1 WO 2018013329 A1 WO2018013329 A1 WO 2018013329A1 US 2017039362 W US2017039362 W US 2017039362W WO 2018013329 A1 WO2018013329 A1 WO 2018013329A1
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WO
WIPO (PCT)
Prior art keywords
vessel
tissue
chamber
heart
catheter
Prior art date
Application number
PCT/US2017/039362
Other languages
English (en)
Inventor
John N. CATANZARO
Original Assignee
University Of Florida Research Foundation, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by University Of Florida Research Foundation, Inc. filed Critical University Of Florida Research Foundation, Inc.
Publication of WO2018013329A1 publication Critical patent/WO2018013329A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00041—Heating, e.g. defrosting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00214—Expandable means emitting energy, e.g. by elements carried thereon
    • A61B2018/0022—Balloons
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00363—Epicardium
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00839—Bioelectrical parameters, e.g. ECG, EEG
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/02—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques
    • A61B2018/0212—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by cooling, e.g. cryogenic techniques using an instrument inserted into a body lumen, e.g. catheter

Definitions

  • the disclosure relates to a system and method for cryoablating tissue that is difficult to access, and particularly for cryoablation of epicardial tissue to ameliorate atrial fibrillation.
  • Ablation of tissues surrounding the pulmonary veins is carried out to disrupt an electrical signal transmitted from the veins into the left atrium, giving rise to atrial fibrillation.
  • One technique for creating this ablation is the Convergent Procedure, which uses radio frequency energy to generate heat which is applied to heart tissue to produce ablation and interrupt the signal.
  • the Convergent Procedure is generally performed in patients with symptomatic persistent atrial fibrillation.
  • An initial part of the procedure utilizes an RF probe or coil which is placed transdiaphragmatically on an exterior surface of the heart on the posterior wall of the epicardium, in an effort to ablate the epicardial posterior wall.
  • the device utilizes RF energy emitted from a generator which is grounded to the patient.
  • a coil apparatus is introduced telescopically onto the epicardium which then uses a vacuum suction while applying the RF energy. The impedance is measured while RF is applied in an effort to confirm that the application of energy is complete, and that sufficient energy has been transmitted to the epicardium in order to cause ablation.
  • ablation is additionally performed inside the heart using electrophysiology.
  • a device is threaded through the femoral artery into the heart, and RF energy is again used to complete portions of the ablation pattern which could not be completed outside the heart.
  • Cryothermal energy has been used inside the heart on the endocardium to ablate the ostium of pulmonary veins, including for example by use of the ARTIC FRONT device of Medtronic, Inc.
  • the device occludes the ostium with a round balloon-like structure which is inserted into the ostium to make contact with body tissue, and which is then filled with a coolant to cause freezing of tissue at the ostium.
  • a method for causing controlled tissue necrosis comprises inserting a catheter into the mediastinum to the posterior side of the heart, adjacent the left ventricle; admitting a first gas or liquid medium through a lumen of the catheter and into a collapsible and expandable vessel connected to a distal end of the catheter, to thereby expand the vessel to define an interior chamber and longitudinal and transverse axes, the vessel having a flexible outer surface region; guiding the expanded vessel to position the flexible outer surface region into mating and conforming contact with tissue of the heart; admitting a second gas or liquid medium through a lumen of the catheter to cause cooling of the flexible outer surface region; and maintaining the mating and conforming contact for a predetermined time to thereby cause controlled tissue necrosis of the tissue contacted, to thereby block the transmission of natural electrical signals by the tissue.
  • the position of the expanded vessel is guided by at least one of a steerable catheter or guide wire; the vessel is fabricated with a flexible polymer; the vessel includes a plurality of pathways for conducting the first and second gas or liquid medium separately; the first and second gas or liquid medium are the same medium; the method further includes applying suction to a channel within the vessel having apertures opening from the channel to an exterior of the vessel to cause the vessel to be adhered to body tissue; and/or the second gas or liquid medium is nitrogen.
  • the method further includes using a plurality of sensors connected to the vessel for detecting electrical signals emanating from the body; measuring an electrical signal using a plurality of sensor at different areas along a surface of the vessel to determine a change in electrical transmission after tissue necrosis; and/or using at least one sensor to determine if the flexible outer surface region is in contact with tissue of the heart; and/or the at least one sensor is used to determine if the vessel is positioned in the correct location upon the heart.
  • the catheter is inserted laparoscopically; the vessel includes a shape memory wire frame; and/or the vessel further including electrodes positioned to stimulate the heart with an electrical signal.
  • a device for causing controlled tissue necrosis comprises a collapsible and expandable chamber including a flexible outer surface region; a lumen connected to the chamber through which a gas or liquid can be passed to enter into an interior of the chamber, and be withdrawn from the chamber, the gas or liquid operative to expand the chamber from a collapsed state; one or more apertures extending to an exterior of the chamber; a channel in communication with the one or more apertures through which a vacuum can be applied to cause suction at the one or more apertures; and one or more sensors connected to the chamber.
  • the position of the expanded chamber is guided by at least one of a steerable catheter or guide wire; the chamber is fabricated with a flexible polymer; the lumen includes a plurality of pathways for conducting first and second gas or liquid medium
  • the first and second gas or liquid medium are the same medium; the applied suction causes the chamber to be adhered to body tissue; and/or the second gas or liquid medium is nitrogen.
  • the one or more sensors connected to the chamber detect electrical signals emanating from the body; measure an electrical signal at different areas along a surface of the chamber to determine a change in electrical transmission after tissue necrosis; determine if the flexible outer surface region is in contact with tissue of the heart; and/or determine if the vessel is positioned in the correct location upon the heart.
  • the catheter is inserted laparoscopically; the chamber includes a shape memory wire frame; and/or the chamber further including electrodes positioned to stimulate the heart with an electrical signal.
  • FIG. 1 depicts a contracted or deflated raft of the disclosure emerging from a catheter
  • FIG. 2 depicts the raft of FIG. 1, partially expanded
  • FIG. 3 depicts a top view of the raft of FIG. 1, fully expanded
  • FIG. 4 depicts a side view of the raft of FIG. 3;
  • FIG. 5 depicts a bottom view of the raft of FIG. 3, illustrating a flexible surface, electrodes, and suction apertures of the disclosure
  • FIG. 6 depicts the raft of FIG. 3 applied to tissue of the heart, proximate the left atrium;
  • FIG. 7 to 11 depict successive applications of the raft of FIG. 3 to tissue of the heart in accordance with the disclosure, with ablated tissue shown in hatched areas;
  • FIG. 12 depicts a bottom view of the raft of FIG. 3, illustrating vacuum and
  • FIG. 13 depicts a bottom view of the raft of FIG. 4, illustrating separate inflation and cooling pathways
  • FIG. 14 depicts the raft of FIG. 3 inserted into the pericardial space proximate a pericardial reflection
  • FIG. 15 depicts the raft of FIG. 3 applied to an exterior surface of the heart
  • FIG. 16 depicts the raft of FIG. 3, including a representative stiffening brace
  • FIG. 17 depicts the raft of FIG. 3, with an alternate lumen attachment point
  • FIG. 18 depicts the raft of FIG. 3, with another alternate lumen attachment point.
  • the terms “a” or “an”, as used herein, are defined as one or more than one.
  • the term plurality, as used herein, is defined as two or more than two.
  • the term another, as used herein, is defined as at least a second or more.
  • the terms “including” and “having,” as used herein, are defined as comprising (i.e., open language).
  • the term “coupled,” as used herein, is defined as "connected,” although not necessarily directly, and not necessarily mechanically.
  • the disclosure provides an inflatable device 100 with a pliable surface 110 which can matingly conform to contact an uneven exterior heart surface, for example a surface including a pericardial reflection. By forming a mating contact, withdrawal of heat energy from the heart surface can be efficiently carried out by cooling the pliable surface 110.
  • device 100 includes a rectangular inflatable vessel or raft 104, defining an interior chamber.
  • raft 104 extends from an attachment region 102 at a point that is lateral to a centerline passing through a middle of device 100 transverse to an axis extending along its longest dimension.
  • attachment region 102 can be formed within the first 10, 20, or 30% of an edge of device 100, to facilitate positioning of device 100 in difficult to access areas.
  • Device 100 can be applied to the heart directly, where a direct open chest approach has otherwise been employed, or can be inserted into the body through a catheter 200, as illustrated, in a minimally invasive procedure.
  • catheter refers to a sheath, passable into the body, and having at least one interior lumen.
  • Catheter 200 can be inserted into the body using currently known or hereinafter developed laparoscopic/thoracoscopy techniques, including for example passing an outer catheter or sheath (not shown) into the mediastinum via any known approach, for example via a subxiphoid access, and passing catheter 200 through this outer sheath.
  • Insertion may also be achieved through transthoracic insertion ports, for example through a skin incision in the intercostal space.
  • a minimally invasive process includes passing the outer sheath through the diaphragm, as is carried out in the Convergent Process.
  • a pneumothorax by introducing carbon dioxide gas into the pleural space to improve a view of the surgical field.
  • Additional instruments can be passed through the same sheath as device 100, or through other insertion points. These additional instruments can include tools for visualization, such as a camera, or tools for lavage, surgical repair, or sensors and other test devices.
  • device 100 is emerging from an open end of catheter 200, pushed by a flexible lumen 108 connected to raft 104 at attachment point 102.
  • all of the structure for forming raft 104 have been released from catheter 200.
  • raft 104 can be inflated or expanded by the introduction of a gas or liquid medium.
  • one or more braces 112 can be attached to raft 104 to promote or form a particular desired opened or deployed shape, or to help form a desired shape during inflation.
  • Braces 112 can be formed from shape memory wire, such as NITINOL, for example, so that they may be readily compressed during deployment and retrieval.
  • shape memory wire such as NITINOL
  • device 100 can be formed with a single lumen (not shown) which carries out the functions of lumen 108 and catheter 200.
  • raft 104 can be inserted into an end of the single lumen, and can emerge when inflated. During retrieval, raft 104 can simply be deflated and pulled behind the single lumen out of the body.
  • raft 104 can be provided with a curved shape, to best conform to a contour of the target tissue, in the example illustrated the posterior portion of the left atrium.
  • Raft 104 can be curved along two or more planes, or can form a complex shape to match corresponding tissue structures.
  • pliable surface 110 or any other area which defines the portion of a surface of raft 104 that is cooled, can have a curved or complex shape, which can be used in turn to define a pattern of tissue necrosis.
  • One or more vacuum apertures 120 can be provided upon a tissue contacting surface of raft 104, proximate or upon pliable surface 110.
  • a suction is applied to one or more channels or tubes 122, which open at one or more apertures 120, as can be seen in FIG. 12.
  • pliable surface 110 can be pulled against body tissue which is to be the subject of cryoablation, increasing efficiency, and reducing exposure of adjacent tissue to unwanted cooling.
  • Tube 122 passes through lumen 108 and out of the body, where it can be connected to a pump in a known manner.
  • arrow ' V illustrates a vacuum applied to tube 122. It should be understood that this vacuum pathway is separated from inflation/cooling pathways A, B, and C described elsewhere herein.
  • One or more electrodes or sensors 126 are provided on one or more sides of raft 104, connected by an electrical cable 128.
  • sensors 126 detect natural electrical signals emanating from the body, for example electrical signals emanating from the pulmonary veins which may tend to produce atrial fibrillation.
  • the cryoraft may be used to voltage map the epicardium through two or three dimensional anatomic mapping, and identify possible areas of epicardial fat and or pericardial reflections due to their increased resistance to the flow of electricity.
  • raft 104 When raft 104 is positioned for ablation, typically one side of raft 104 will face one or more pulmonary veins, and another side will face the center of the atrium. By positioning sensors 126 on opposite sides of raft 104, it may be confirmed whether signals emanating on the vein side have been successfully interrupted by tissue necrosis or scar formation, and do not appear on the atrium side of raft 104.
  • Sensors 126 can additionally be used to confirm that raft 104 is in a therapeutically beneficial location as evidenced by a strong signal emanating from the veins which is likely to be contributing to atrial fibrillation. Sensors 126 can additionally or alternatively be used to confirm contact with body tissue, for example by measuring capacitance or physical resistance, so that it may be known that pliable surface 110 is in contact with tissue to be cryoablated. Sensors 126, or other materials within or upon raft 104, can be used for electroanatomically mapping a location of raft 104, using known or hereinafter developed techniques. Once the location is confirmed by sensor 126 data, and or any of visible light camera information, transesophageal echocardiogram (TEE), C-arm imaging, or any other known or hereinafter developed imaging or locating method, application of cryoablation can begin.
  • TEE transesophageal echocardiogram
  • Sensors 126 can be provided in the form of electrodes which can transmit an electrical signal to the heart in order to stimulate a therapeutic or diagnostic reaction, for example cardioversion or fibrillation.
  • a pre- or partial cooling of body tissue can be carried out, without causing tissue necrosis, and sensors 126 can be used to determine an extent of change in the transmission of electrical energy across pliable surface 110. In this manner, before tissue necrosis is brought about, the potential efficacy of cryoablation can be estimated.
  • device 100 has been positioned adjacent to the pulmonary veins from the left lung 308, in order to perform one of a series of ablations corresponding to a technique for obstructing all signals which give rise to atrial fibrillation, for example according to the Maze pattern, or a pattern as employed for the Convergent Procedure.
  • raft 104 is positioned at successive locations along the exterior surface of the heart, to produce a continuous line, or other desired pattern, of scar tissue (hatched area) which does not transmit undesirable electrical signals.
  • catheter 200 can be of the deflectable or steerable type, or a catheter with an inserted steerable guidewire. Examples of a steerable catheters with a lumen that can be used in accordance with the disclosure are the Medtronic FLEXCATH ADVANCE steerable sheath or the Abbot steerable guide catheter No. SGC0101, although other types are known.
  • inflation can be carried out by admitting pressurized gas or liquid into raft 104 through lumen 108.
  • a gas or a liquid medium is admitted into raft 104, and during cooling, cold gas or liquid replaces the previous medium,
  • a plenum 124 forms a pathway for conducting the gaseous or liquid inflation/cooling medium throughout an interior of raft 104. More particularly, a medium is admitted into raft 104 at a port indicated by arrow ⁇ ', passes to a distal end of raft 104 at arrow ' ⁇ ', and exits at arrow 'C . In this manner, efficient circulation of the medium throughout raft 104 can be carried out. While a single pathway is shown, multiple pathways can be provided. As shown in FIG.
  • the optional vacuum pathway 122 and sensors 126 are not shown in FIG. 13, for clarity.
  • device 100 is advantageously applied as close to the myocardium as possible. This can be carried out, in one embodiment shown in FIG. 15, by forming a pericardial window using known techniques, and inserting device 100 between the parietal and visceral layers 320, 322, respectively. However, freezing of myocardial tissue through the entire pericardium, as shown in FIG. 15, can also be carried out using device 100 as described herein.
  • FIG. 17 illustrates that raft 104 can be provided in 'left' and 'right' handed versions, wherein attachment point 102 extends from alternate ends of raft 104. While an entire procedure can be carried out using one form or the other, for particular anatomy, it may be advantageous to have both forms available for difficult to access locations. As illustrated in FIG. 18, attachment point 102 can be provided along a short side 130 with lumen 108 extending coaxially with a longest axis of device 100.
  • raft 104 or cooled and pliable surface 110 is sized according to the dimensions of the smallest area to be ablated.
  • a compromise size can be used.
  • a width of surface 110 is determined by the objectives of the procedure with respect to the dimensions of the scar tissue to be produced by each application of device 100.
  • surface 110 can be between about 5 and about 60 mm wide, and about 10 and about 120 mm long.
  • a height of raft 104 can be determined by the maximum clearance at all locations into which device 104 must be inserted, which in FIGS. 6-11 is between about 2 and about 60 mm. It should be understood that dimensions are also determined by the patient physiology, and accordingly, larger or smaller dimensions can be used. However, as raft 104 is inflatable, it may be deflated for narrow confines. In an
  • raft 104 when it is desired to press pliable surface 110 against a target area to be ablated, raft 104 can be inflated until an opposing surface is contacted and a desired compression force is achieved, detectable for example with one or more sensors, whereby raft 104 is pushed against the target area to create better contact between body tissue and surface 110.
  • Raft 104 can be fabricated from a flexible biocompatible material that is capable of retaining an inflation gas or liquid, and a cooling gas or liquid if different.
  • a flexible biocompatible material that is capable of retaining an inflation gas or liquid, and a cooling gas or liquid if different.
  • examples include at least one of polyethylene, polypropylene, polystyrene, polyester, polyester, polycarbonate, polyvinyl chloride, polyethersulfone, polyacrylate (acrylic, PMMA), hydrogel (acrylate), polysulfone, polyetheretherketone, thermoplastic elastomers (TPE, TPU), thermoset
  • elastomers silicone, poly-p-xylylene (PARYLE E), and fluoropolymers, and shape memory polymers.
  • Air and/or cooling medium can include, for example, air, oxygen, liquid and/or nitrogen gas, water or water with an anti-freeze constituent added, ether, propylene, or a gel. Cooling medium should be capable of reaching temperatures sufficiently low to cryoablate the target tissue through the material of pliable surface 110, as well as through any surface tissues including fatty tissue. For example, temperatures substantially below zero degrees Celcius at a contact surface of pliable surface 110 is advantageous. Particularly, for the myocardium, a tissue temperature of -40 degrees C or less for several minutes has been found sufficient to achieve a controlled extent of tissue necrosis which has the effect of blocking undesired electrical signals without unduly compromising proper tissue functioning.
  • a relatively warmer gas or liquid medium can be introduced into raft 104 in a similar manner as described for the cold medium, and the temperature can be raised to a point where tissue necrosis is discontinued, or a desired tissue temperature is achieved.
  • a heated gas or liquid medium may alternatively be delivered into contact with pliable surface 110 in a like manner as described, the medium having a temperature sufficient to cause the desired extent of tissue necrosis.
  • a cooling liquid can be introduced in order to discontinue necrosis.
  • cooling can yield faster recovery times, with a more uniform extent of necrosis.
  • pliable surface 110 can be provided with a peltier device which produces either cold or heat at a tissue contacting surface.
  • the undesired heat or cold energy produced by the device on an opposing, interior side can be extracted using the medium pathways described herein.
  • tissue ablation can be carried out on the endocardium in an interior of the heart using any known method, including using raft 104 in a like manner as described herein, as needed in order to complete a blockage of undesired electrical signals.
  • the disclosure provides a non-occlusive "raft" balloon 104 which can be deployed onto the epicardium, and which can contain sensors 126 which can detect electrical signals and/or determine proper contact of the raft with body tissue. Cryothermal energy is delivered after the balloon is inflated and contact is confirmed.
  • the raft enables freezing around epicardial fat or through the fat, while also offering the capability to provide contact upon the pericardial reflections which cannot be contacted via an RF probe.

Abstract

Pour provoquer une nécrose tissulaire contrôlée, un cathéter est inséré dans le médiastin, jusqu'au côté postérieur du coeur, adjacent au ventricule gauche. Un milieu gazeux ou liquide est passé à travers le cathéter et dans un vaisseau repliable et expansible relié à une extrémité distale du cathéter, afin d'étendre le vaisseau pour définir une chambre intérieure. Le vaisseau a une région de surface externe flexible, qui est guidée vers une région qui épouse le tissu du coeur. Un second milieu gazeux ou liquide est passé à travers le cathéter pour provoquer le refroidissement de la région de surface externe souple, tout en maintenant le contact avec le coeur pendant une durée prédéterminée, ce qui provoque la cryoablation qui bloque la transmission indésirable de signaux électriques naturels par le tissu.
PCT/US2017/039362 2016-07-15 2017-06-27 Cryoablation épicardique WO2018013329A1 (fr)

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US201662362619P 2016-07-15 2016-07-15
US62/362,619 2016-07-15

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Citations (8)

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US6283959B1 (en) * 1999-08-23 2001-09-04 Cyrocath Technologies, Inc. Endovascular cryotreatment catheter
US6314963B1 (en) * 1996-10-22 2001-11-13 Epicor, Inc. Method of ablating tissue from an epicardial location
US20020065512A1 (en) * 2000-07-13 2002-05-30 Todd Fjield Thermal treatment methods and apparatus with focused energy application
US6428534B1 (en) * 1999-02-24 2002-08-06 Cryovascular Systems, Inc. Cryogenic angioplasty catheter
US20090299355A1 (en) * 2008-05-27 2009-12-03 Boston Scientific Scimed, Inc. Electrical mapping and cryo ablating with a balloon catheter
US7727228B2 (en) * 2004-03-23 2010-06-01 Medtronic Cryocath Lp Method and apparatus for inflating and deflating balloon catheters
US20100228239A1 (en) * 2009-03-09 2010-09-09 Cytyc Corporation Ablation device with suction capability
US20110160645A1 (en) * 2009-12-31 2011-06-30 Boston Scientific Scimed, Inc. Cryo Activated Drug Delivery and Cutting Balloons

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6314963B1 (en) * 1996-10-22 2001-11-13 Epicor, Inc. Method of ablating tissue from an epicardial location
US6428534B1 (en) * 1999-02-24 2002-08-06 Cryovascular Systems, Inc. Cryogenic angioplasty catheter
US6283959B1 (en) * 1999-08-23 2001-09-04 Cyrocath Technologies, Inc. Endovascular cryotreatment catheter
US20020065512A1 (en) * 2000-07-13 2002-05-30 Todd Fjield Thermal treatment methods and apparatus with focused energy application
US7727228B2 (en) * 2004-03-23 2010-06-01 Medtronic Cryocath Lp Method and apparatus for inflating and deflating balloon catheters
US20090299355A1 (en) * 2008-05-27 2009-12-03 Boston Scientific Scimed, Inc. Electrical mapping and cryo ablating with a balloon catheter
US20100228239A1 (en) * 2009-03-09 2010-09-09 Cytyc Corporation Ablation device with suction capability
US20110160645A1 (en) * 2009-12-31 2011-06-30 Boston Scientific Scimed, Inc. Cryo Activated Drug Delivery and Cutting Balloons

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